By Annie Schuster, PharmD, FAMCP, VP, Clinical Effectiveness & Stars Experience
The CY 2027 Medicare final rule does not adjust Star Ratings. It restructures them. CMS has removed 11 administrative and process measures—appeals timeliness, call center performance, language interpreter availability, grievance handling—eliminating the procedural buffer that allowed plans to offset weak clinical performance with strong process scores. The Excellent Health Outcomes for All reward bonus is also gone, closing the last alternative pathway to a higher composite rating without improving clinical outcomes.
What remains includes measures that were always challenging to move: medication adherence for diabetes, hypertension, and cholesterol, along with member experience (CAHPS). CMS is focused more on clinical care, outcomes, and member experience of care measures. There is no longer an adjustment mechanism, a process offset, or a bonus pathway that compensates for inadequate medication adherence scores. The math has changed, and the plans that understand what this means for their pharmacy partnerships will be the ones that hit quality bonus cut points.
For years, plans with uneven clinical performance could absorb that unevenness. The administrative denominator was large enough, and the process measures reliable enough, to keep a plan above a critical Star Ratings cut point even when adherence numbers lagged. The CY 2027 rule eliminates that math. Every remaining measure carries more relative weight, and the highly weighted clinical and experience measures dominate the calculation with no administrative dilution.
This is not a gradual shift. It is a structural change to how CMS evaluates plan quality. The CMO and Quality teams who understood that medication adherence was important but depended on administrative measures to absorb the gap between “important” and “performing” just lost the mechanism that made that gap survivable.
What Else Changed in the CY 2027 Medicare Final Rule
Beyond the measure restructuring, several other regulatory decisions in the final rule deserve attention. CMS finalized a depression screening and follow-up measure for the 2027 measurement year, signaling where Star Ratings clinical measures are headed next. The opioid use disorder medication-assisted treatment measure that was proposed was not adopted, a relief for plans that had begun evaluating the operational implications.
Medication Measures Hold Tremendous Weight
Many measures that survived CMS’s administrative purge require safe and appropriate medication use including:
- Medication Adherence for Diabetes (proportion of days covered)
- Medication Adherence for Hypertension (proportion of days covered)
- Medication Adherence for Cholesterol (proportion of days covered)
- Statin Use in Persons with Diabetes
- Use of Multiple Anticholinergic Medications in Older Adults
- Concurrent Use of Opioids and Benzodiazepines
- Member Experience / CAHPS (including Getting Needed Prescription Drugs)
Clinical pharmacists are key members of the healthcare team and ensure medications are filled, refilled on time, clinically appropriate in the context of the full medication regimen, and taken as directed. The distance between a prescription written and a medication consistently and appropriately taken is the distance these measures quantify, and it is a distance that pharmacy clinical services directly close.
Pharmacy is no longer a support function managed through the PBM’s rebate optimization framework. It is the performance lever. The question for every Medicare Advantage CMO and Quality team is not whether pharmacy clinical services matter for Star Ratings; the CY 2027 rule just answered that. The question is whether your current pharmacy strategy is designed to continuously improve these highly weighted measures or merely to adjudicate claims.
AnewHealth’s clinical pharmacy platform addresses medication adherence and optimizing medication use at the population level. MedWise technology enables multi-drug analysis to identify health risks and mitigate adverse drug events, targeting the medication risk that drives non-adherence before it becomes a missed dose. Across the platform, more than 150,000 people nationwide trust AnewHealth with their medications, with over 13 million prescriptions delivered in 2025, a clinical pharmacy operation at the scale these measures require.
AnewHealth doesn’t just improve medication adherence, it improves how members experience their plan. CAHPS scores are weighted in both Part C and Part D Stars and directly reflect how members experience their plan’s coordination of care and ease of getting needed medications. AnewHealth’s annual patient experience survey results consistently show AnewHealth delivery makes it easier to get medications, a measure aligned with the Medicare Advantage Prescription Drug plan CAHPS questionnaire.
The Depression Screening Measure: A 2029 Signal for Pharmacy Care Management
The CY 2027 final rule finalized a depression screening and follow-up measure for the 2029 Star year. While the specifics of measure weighting have not been confirmed, the trajectory is clear: CMS is expanding Star Ratings into behavioral health care that intersect directly with medication therapy optimization.
Depression is not only a behavioral health concern. It is a medication adherence barrier. Members with untreated or undertreated depression demonstrate lower medication adherence across chronic conditions, including the diabetes, hypertension, and cholesterol regimens that current Star Ratings measures evaluate. A depression screening measure creates a formal connection between behavioral health identification and clinical intervention, and for organizations with integrated clinical pharmacy workflows, it creates an opportunity to demonstrate that connection at the population level.
Health plans that begin integrating mental health signals into medication therapy optimization workflows now—identifying members whose depression may be driving non-adherence across other chronic conditions, coordinating with behavioral health providers, adjusting medication risk assessments to account for behavioral health complexity—will be positioned when this measure arrives. Organizations with clinical pharmacy platforms that already assess full medication regimens, including behavioral health medications and their interactions with chronic disease therapies, have the workflow foundation to incorporate depression screening signals without building new infrastructure. Plans that wait for the 2027 measurement year will be building from scratch under a deadline.
This is not a 2029 problem. It is a 2027 planning decision.
What the Medicare Final Rule 2027 Means for Your Star Ratings Strategy
For health plan CMOs, Pharmacy Directors, and ACO quality leaders, the strategic question is straightforward: does your current pharmacy partner have the clinical infrastructure to move these medication measures that now constitute more weight?
If your pharmacy strategy is operational—dispensing, packaging, claims processing—the CY 2027 rule just made the distance between that approach and pharmacy clinical services visible in your Star Rating. The measures that carry the weight are not going to be moved by rebate optimization or claims adjudication. They require population-level medication risk identification, proactive intervention on non-adherence, and full-regimen clinical oversight.
AnewHealth works with health plans and ACOs to assess medication performance and build clinical pharmacy strategies aligned to measures that define Star Ratings. If your team is working through what the CY 2027 final rule means for your quality strategy, that is a conversation worth having now, before bid submissions close and the measurement year begins.
